Name = Hematemesis
DiseasesDB = 30745
ICD10 = ICD10|K|92|0|k|92
ICD9 = ICD9|578.0
eMedicineSubj = med
eMedicineTopic = 3565
MeshName = Hematemesis
MeshNumber = C23.550.414.788.400
Hematemesis or haematemesis (see American and British spelling differences) is the
vomitingof blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis(coughing up blood), although the former is more common.
Signs of the onset of hematemesis may include:
* A history of excessive alcohol use or
* Any esophago-gastric symptoms, such as nausea or vomiting
* Brown or black vomit
* Vomit that looks like coffee grounds
* Dark colored, tar like stools (a condition known as
Causes can be:
* Prolonged and vigorous
retching(may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called Mallory-Weiss syndrome).
* Irritation or erosion of the lining of the
* Bleeding ulcer located in the
stomach, duodenum, or esophagus
* Ingested blood (for example, swallowed after a nosebleed)
Vomitingof ingested blood after hemorrhagein the oral cavity, nose or throat
* Vascular malfunctions of the
Tumors of the stomachor esophagus
Mallory-Weiss syndrome(esophageal tear)
Wilson's disease(hepatolenticular degeneration)
Ebolaor Marburg Virus
Hematemesis is treated as a
medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.
Minimal blood loss
If this is not the case, the patient is generally administered a
proton pump inhibitor(e.g. omeprazole), given blood transfusions (if the level of hemoglobinis extremely low, that is less than 8.0 g/dL or 4.5-5.0 mmol/L), and kept nil per os(nil by mouth) until endoscopycan be arranged. Adequate venous access (large-bore cannulas or a central venous catheter) is generally obtained in case the patient suffers a further bleed and becomes unstable.
ignificant blood loss
In a "hemodynamically significant" case of hematemesis, that is
hypovolemic shock, resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomyis necessary.
Upper gastrointestinal bleeding
* [http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm NIH/Medline]
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